Healthcare Provider Details

I. General information

NPI: 1063498160
Provider Name (Legal Business Name): PARK PLEASANT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 CHESTER AVE
PHILADELPHIA PA
19143-3513
US

IV. Provider business mailing address

4712 CHESTER AVE
PHILADELPHIA PA
19143-3513
US

V. Phone/Fax

Practice location:
  • Phone: 215-727-4450
  • Fax: 215-724-6596
Mailing address:
  • Phone: 215-727-4450
  • Fax: 215-724-6596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number420302
License Number StatePA

VIII. Authorized Official

Name: NANCY JUDITH KLEINBERG
Title or Position: OWNER
Credential:
Phone: 215-727-4450